Introduction
Over
the past two decades, obesity has made its way to the forefront of our nation’s
health issues. This is not only an issue
for the adult population, given that it is estimated that 16.9% of American
children between the ages of 2 and 19 years old are obese (1). There are a number of social consequences of
childhood obesity which include increased risk of depression, lower
self-esteem, lower self-acceptance, and lower life satisfaction (2). In
addition, there are also increased risks for cardiovascular disease and
all-cause mortality in those that are overweight during their childhood years
(3). It is well known that an effective
intervention is necessary to slow the increasing number of children that are
overweight and obese. A number of
interventions have been implemented, yet positive results have yet to be
seen.
One such intervention that has been implemented in Georgia
is called Strong4Life (4). The focus of
this campaign is to “stop sugarcoating,” and be blunt with the people of
Georgia to get them to make a positive change and stop childhood obesity. The campaign includes billboards with
pictures of overweight children and sayings such as “Fat prevention begins at
home. And the buffet line,” and “It’s
hard to be a little girl if you’re not.” (5)
These billboards have stirred up quite the commotion amongst residents
of the Atlanta, Georgia community. Many
feel that such a frank campaign will not be effective in stimulating a constructive
change, but instead will further stigmatize the children that are overweight
and obese (5). This may also not be the
most effective way to motivate children and their parents to adopt a healthy
lifestyle.
There are obviously a number of people that believe that
this is the most effective way to approach the problem of childhood
obesity. Linda Matzigkeit, vice
president of Children’s Healthcare of Atlanta, says, “It has to be harsh. If it’s not, nobody’s going to listen.” (6) On the surface, this might seem to be a
logical explanation. However, there is a
large body of research that suggests that this is not the most effective
mechanism of motivating these youngsters and their parents. There are a few inherent flaws that are
detrimental to the design of this intervention, which include the stigmatization
of overweight youth, the use of low self-efficacy messages, and the use of fear
as a motivation to get people to do something.
Looking at these more in depth will show the ineffectiveness that this
intervention is bound to experience.
Flaw
1: Stigmatizing overweight youth
The Strong4Life campaign
is very centralized on the theory of the Health Belief Model. The Health Belief Model is based on the
thought that there are four motivating factors to a person's actions: perceived
susceptibility, perceived severity, perceived benefits of an action, and
perceived barriers to taking that action (7).
While in theory this seems to make sense from a health perspective,
there are a number of reasons why this limits the scope of the Strong4Life
campaign. This model does not apply well
to long-term interventions; it is only really effective when it is a one-time
thing that you are trying to motivate people to do (8). This obviously is not promising when applied
to a program where the main intended outcome is weight loss. This model also assumes that the person is in
a vacuum and is not influenced by other people, and that people’s actions are
reasoned and planned. In addition, a
major assumption that is made is that people value their health more than other
things. This assumption is made in the
Strong4Life campaign, and it is definitely one of the bigger flaws of the
program (8). With this program, they are
assuming that the parents, who are the intended audience, care more about the
health of their children than the freedom to live as they want. Even though many of the parents of overweight
and obese children obviously do care about the health of their children,
threatening to take away their freedom to eat and live as they want is more frightening
than taking away their health.
In addition to utilizing the Health Belief Model, the ads
and commercials used for the Strong4Life campaign show images of overweight and
obese children in a negative semblance. The
billboard ads in particular consist of pictures of overweight youth written
over with a bold red “WARNING” label with things such as “Chubby kids may not
outlive their parents” written underneath (5).
Overweight and obese youths and adults already deal with so much
negative energy in other aspects of their lives that this is only distressing
them more. In a study by Sutin and
Terracciano, it was shown that weight discrimination is associated with factors
that can cause obesity, including excessive caloric intake and lack of physical
activity (2). They found that for the
participants that were not obese at baseline, those that were exposed to weight
discrimination were 2.5 times more likely to become obese by follow-up, which
was 4 years later (2). This demonstrates
how negative language such as the words “fat” and “chubby” are only further
demoralizing these children and their parents.
Not only are these ads stigmatizing overweight and obese children, they
are causing more anxiety and perpetuating the problems that these kids are
already having to deal with. Other
studies have shown that stigmatizing weight may worsen such medical conditions
as hypertension, cortisol reactivity and also the risk for hypertension
(9). By branding these children with
words such as "fat," these ads are likely promoting the risk for
further psychological and physical health problems.
Flaw
#2: Lack of self-efficacy-inducing motivation
The negativity that these ads bring about not only defames
those that are supposed to be helped by them, but also they do not allow for
any self-efficacy to be shaped. How
effective can a campaign truly be when it is not motivating and instead is giving
its target audience the feeling that they have already lost their battle? The messages that these ads embody go against
the Social Cognitive Theory, which focuses on self-efficacy, or the belief that
you are able to do something (10). This
theory explains the fact that self-efficacy has a large impact on both
motivation and action (10). The
negativity that these ads put forth does not allow the children and parents
that see these ads to achieve a feeling of self-efficacy. They are essentially knocking these children
down and telling them that they have already failed. If these children believe that they have
already failed and that being healthy and losing weight are out of their reach,
they are not going to be motivated to change and try to achieve these
things. They will not believe that they
can lose weight, join a sports team, or even live a healthy life. Social Cognitive Theory also takes into
account that the environment, individual and the behavior can all influence one
another (11). With that being said, if
the environment that is being created is so negative and puts these children
down, that is not going to influence the individual or the behavior in a
positive manner. Most likely, the
behavior will be viewed negatively, and the individual will not feel as if they
are capable to, nor will they want to, do the behavior that the ads are trying
to induce.
The lack of self-efficacy created by these ads goes past
merely affecting the children that are being targeted. These ads are also placing blame on the
parents of these overweight and obese children.
One ad in particular features a child that is overweight, with the
wording, "He has his father's eyes, his laugh, and maybe even his diabetes."
(12) Not only does this ad make the
parents feel as if they have failed their child, but also it is sending a
message to the child that it is his or her parent's fault that he or she is
overweight. Thinking about this in the
terms of the Social Cognitive Theory, this is creating the same negative environment
for the parents, who are supposed to be the intended audience of these
ads. Blaming the parents is inherently
saying that they have done something wrong and that they are "bad"
parents for letting their children get to the unhealthy state that they are
in. This most likely is going to create
a sense of defensiveness for the parents, causing them to not want to listen to
these ads. Overall, these ads have the
same effect as they do on the children, not allowing for self-efficacy or the
feeling that losing weight and living a healthier lifestyle is achievable.
Flaw
#3: Trying to scare the fat out of people
The
frame that this campaign is using is centered around the health consequences of
being overweight. Despite the fact that
for most people health is extremely important, as was mentioned before people are
known to not make decisions rationally.
As with the Health Belief Model, this is an assumption that many other models
used by public health campaigns make (8).
Because people are inherently irrational in their decision making, using
a frame that is focused on health is not always the strongest motivator. Moreover, the way in which this campaign is
framed is very negative. It is
presenting the issue in terms of the loss of health that these children are
encountering. Presenting an issue with
what there is to lose is going to be far less effective than if it is presented
in the form of what there is to be obtained.
It is also known that although in some situations fear may be a good motivator,
it is not always so (13). As reported in
a meta-analysis by Witte and Allen, if a campaign is using fear as a
motivational tactic, it should be used in conjunction with a high-efficacy
message. If fear is used alongside a
low-efficacy message, such as is used by the Strong4Life campaign, there is a
higher chance that the response is going to be more defensive and do the
opposite of what is intended (13). Although
fear can be an effective way of motivating people to do something, the use of
fear needs to be used properly in order get the desired effects.
The
fear devices that the Strong4Life campaign uses can also be related to the Psychological
Reactance Theory. This theory states
that if certain behaviors are threatened with eradication, the person affected
will be motivated to fight for that freedom by however they feel fit (14). This generally results in the person clinging
even more strongly to the threatened belief (15). In this case, by creating such a shocking ad and
threatening the freedom of choice that every American citizen values, the ads
are really generating a reactance that will cause the viewers to hold on to
that freedom. Most likely this will
manifest in the form of continuing with the lifestyle choices that they are
currently making. This therefore
compounds the effect of using stigmatizing and low self-efficacy messages. Essentially, these ads have potential to do
the exact opposite of what the campaign has set out to do.
It is fairly clear that using a scare technique in the
Strong4Life campaign has its downfalls, yet there is another obstacle related
to this that is not addressed by the ads and commercials. This is the fact that the majority of parents
of overweight and obese children do not recognize that their child is at an unhealthy
weight (16). There are a few hypotheses
as to why parents do not recognize when their child's weight is an issue,
including ethnicity, the gender of the child, and the weight status of the
parents (17). This may also be related
to the Law of Optimism Bias, which states that people tend to underestimate
their personal risk of something happening to them even when they overestimate
the risk of that event happening to the general public (18). The combination of parents not recognizing
that their child is overweight and believing that their child is not at a high
risk for developing the negative health outcomes outlined in the ads and
commercials makes for an unsuccessful intervention.
Alternative
Intervention
In taking a closer look at the Strong4Life campaign, it
has become obvious that there are a number of innate flaws that need to be
addressed. In order to do this, a new
program should be put into place. It
would be easiest to start over, reframing the message and painting the picture
in a more positive style. The specifics
of this proposed intervention are outlined in the following sections.
Positivity
matters
A big problem with the Strong4Life campaign which was
outlined above is that it stigmatizes the overweight youth that it
targets. For this new proposed
intervention, billboards will be used but instead of showing one overweight
child they will feature a number of different people. There will be some showing families,
including those who are overweight or obese, spending time together. All of the people in the ad will be happy and
smiling. Other ads will feature groups
of children playing sports together or even just being outside together, but
also having a good time doing so. The
purpose of these ads will be to get the children to join the movement to become
healthier. To do this, there will be
messages written at the bottom of the billboards such as, "Join in the
movement!" and "Let's move together!" By having groups of children or families on
the billboards, this takes away the stigmatizing factor of having just one
overweight child on the billboard covered with negative words. These new billboards will create a sense of
community and they will target both the parents and children. This will make joining the movement more like
joining a group, making the participants feel as if they are a part of
something positive. There will be a
website listed on the ads as well, so that those who want to become a part of
the change will have resources that will help them to do so. On this website, participants will also have
the option to get certain merchandise. Having
things such as t-shirts or bracelets with the movement logo on it will allow
those involved to feel even more a part of the group. This can create a sense of ownership, which
in this case would be the feeling that one owns the idea of being healthy (19). One successful anti-smoking campaign that has
used this technique is The 8ighty 4our, which targets youth that do not smoke
and has essentially created a community of people that are proud of not smoking
(20). Using this approach for losing
weight and getting healthy can create a feeling of attachment to the idea of
being healthy, and should motivate people to not only work hard at achieving
that goal but to also hold it closer with the more work that they put towards
living a healthy lifestyle (19). Presenting
eating healthy and exercising more in this manner will allow the children and
their parents to see these ads and respond to them in a more positive fashion.
Induce
self-efficacy
Along with creating a more positive message for the youth
and their parents that are the target audience of this new proposed campaign,
using messages that more strongly promote self-efficacy will be employed. The billboards that target more of the youth audience
should still feature children that are overweight or obese so that those
viewing the ads will be able to relate to them.
However the messages will be things such as a group of kids playing a
sport, for instance basketball. This
will show the viewers that they are capable of being athletic and that they
should not be afraid to join a sports team. A child that sees this ad and is motivated to
try a sport that they were previously too intimidated to try may be able to
become more active and gain more self-esteem, which are positive changes all
around. In order to also target the
parents through this campaign, some billboards should feature pictures of
families engaging in physical activity together, or even cooking with healthy
foods together. This should have the
same effect of promoting self-efficacy for the parents, showing them that it is
possible to make positive changes for their families and that it is important
to work together to achieve these goals.
In doing this, it is also allowing for both the parents and children to
feel a sense of responsibility, instead of placing blame on the parents for
causing their children to be unhealthy.
Re-framing
the message
Rather than using scare tactics to motivate people to get
healthy, it would be beneficial for this new proposed campaign to focus on
something different than merely health. A
more effective way to frame this message would be to use freedom as a core
value. This can be used by framing being
healthy and active as a way to express one’s freedom and ability to do whatever
he or she aspires to do. This is related
to the ads inducing self-efficacy; they should make people inspired and make
them desire to live their lives as the people depicted in the billboards
do. Moreover, by reframing the
intervention in order to entice people to join the movement, the fear tactics
need not be used. As was discussed,
using fear as a motivator does not always work, and has to be used with higher
self-efficacy messages (13). This new ad
campaign will eliminate the need for the use of fear as a motivator, focusing
solely on the positive that can come from adopting healthy behaviors.
Another approach that will be used to target both parents
and children is to use people that are overweight or obese in the billboards,
but to present them more positively. It
has been shown that people are more likely to be swayed by someone that is
similar to them rather than someone who is different (21). By using adults that are overweight, the
intended audience of the parents will be more likely to agree with the message
and be encouraged to join the movement.
The same goes for the children if kids that are overweight are featured
in the billboards, the targeted audience of overweight and obese kids will be
more likely to listen to the message that the ad is putting forth. In addition, by presenting this demographic
in a more positive way, there will hopefully be less social stigma around
weight. This could potentially help to
ease some of the social and psychological anxiety that many overweight and
obese children experience.
Conclusion
It has become increasingly evident that childhood obesity
is an enormous problem in the United States and around the world. Developing an appropriate intervention to
help stop the increasing numbers of overweight and obese children throughout
the world is extremely important. Obese
children are known to have an increased risk of cardiovascular disease and
all-cause mortality than those children that are of normal weight (3). In addition to these physical health risks,
overweight and obese children have a higher risk of psychological issues such
as depression, low self-esteem and self-acceptance as well as lower life
satisfaction in general (2). If something
is not done to successfully slow and eventually stop this trend, the entire
planet will be dealing with excessive health problems that we may not
necessarily be equipped to deal with.
Many interventions have been attempted in vain, including
the Strong4Life campaign. The flaws of
this campaign were highlighted in this critique and were based on a number of
different behavioral and social theories.
Specifically, those used to analyze the Strong4Life campaign were the
Health Belief Model, Social Cognitive Theory, Framing Theory, Psychological
Reactance Theory and the Law of Optimism Bias.
By using these different theories, it was determined that the
Strong4Life campaign, which includes billboard ads and a few commercials
featuring similar messages, is inherently flawed based on a few different
reasons. These flaws were centered on
the stigmatization of overweight youth, the use of low self-efficacy messages,
and the use of scare tactics. In
determining these flaws, a new intervention has been proposed which is based on
the very theories that prove the Strong4Life campaign is unsound. This new intervention will feature billboard
ads that display messages such as “Join in the movement!” over pictures of kids
playing sports together, or families cooking healthy meals together. There will be no negative images of any
person, child or adult, and there will be no blaming of any particular
person. Further information will be
available at the website provided on the billboard where a person will be able
to get further information on how to get healthy, as well as purchase items
such as t-shirts or bracelets that exhibit the movement logo. By being positive and showing kids and
parents that they are capable of achieving a healthy lifestyle, this crusade will
embody higher self-efficacy, a sense of ownership and commitment, as well as a
sense of community. These different
methods, when used in conjunction, will hopefully aid in the fight against
childhood obesity.
References
1.
Ogden
C, Carroll M. Prevalence of obesity
among children and adolescents: United States, Trends 1963-1965 through
2007-2008. Health E-stat. 2010; 1-5.
2.
Sutin
AR, Terracciano A. Perceived weight
discrimination and obesity. PLoS One
8(7): e70048.
3.
Must
A, Strauss RS. Risks and consequences of
childhood and adolescent obesity. International Journal of Obesity. 1999;23:s2-s11.
4.
Children’s
Healthcare of Atlanta. Strong4Life.
Atlanta, GA: Children’s Healthcare of Atlanta.
http://www.strong4life.com/default.aspx.
5.
ABC News. ‘Stop
sugarcoating’ child obesity ads draw controversy. Atlanta, GA: ABC News. http://abcnews.go.com/Health/Wellness/stop-sugarcoating-child-obesity-ads-draw-controversy/story?id=15273638
6.
NPR. Controversy
swirls around harsh anti-obesity ads. NPR:
http://www.npr.org/2012/01/09/144799538/controversy-swirls-around-harsh-anti-obesity-ads
7.
Edberg
M. Individual health behavior theories (pp. 35-49). In: Edberg M. Essentials of Health
Behavior. Sudbury, MA. Jones and Bartlett Publishers, 2007.
8.
Seigel
M. Social and behavioral sciences for
public health. Boston University. October
10, 2013 Lecture.
9.
Puhl
RM, Latner JD. Stigma, obesity and the health of the nation's children. Psychological Bulletin.
2007;133(4):557-580.
10.
Bandura
A. Social cognitive theory of
self-regulation. Organizational Behavior
and Human Decision Processes. 1991;50(2):248-287.
11.
Seigel
M. Social and behavioral sciences for
public health. Boston University.
October 17, 2013 Lecture.
12.
About-face. Georgia's Strong4Life campaign relies heavily
on fat-shaming. http://www.about-face.org/georgias-strong4life-campaign-relies-heavily-on-fat-shaming/
13.
Witte
K, Allen M. A meta-analysis of fear appeals: Implications for public health
campaigns. Health Education and Behavior.
2000;27(5):591-615.
14.
Brehm
JW. A theory of psychological reactance (pp. 377-390). In: Burke WW, Lake DG, Waymire JP.
Organization change. San Francisco, CA.
John Wiley & Sons, Inc, 2009.
15.
Seigel
M. Social and behavioral sciences for
public health. Boston University.
November 21, 2013 Lecture.
16.
Etelson
D, Brand DA, Patrick PA, Shirali A. Childhood obesity: do parents recognize
this health risk? Obesity Research. 2003;11(11):1362-8.
17.
He
M. Are parents aware that their children are overweight or obese? Do they care?
Canadian Family Physician.
2007;53(9):1493-1499.
18.
Ariely
D. The high price of ownership; why we overvalue what we have (pp. 167-182).
In: Ariely D. Predictably Irrational.
New York, NY. HarperCollins Publisher, 2010.
19.
Seigel
M. Social and behavioral sciences for
public health. Boston University.
December 5, 2013 Lecture.
20.
The
8ighty 4our. Youth fighting for a tobacco-free generation in Massachusetts. http://the84.org/
21.
Roskos-Ewoldsen
D, Fazio RH. The accessibility of source likability as a determinant of
persuasion. Personality and Social Psychology Bulletin. 1992;18(1):19-25.
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